UPDATE: [physician, career options, life options]

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UPDATE: [physician, career options, life options]

Postby letsgobobby » Wed Apr 24, 2013 5:13 pm

Update 2/28/14:
I am bumping this old thread for more thoughts and a more specific question.

Forget all the alternative careers. I just want to work less. For me, going to 0.8 FTE would maintain my health insurance but cut my pay by about 30-35%, because I'd give up some administrative duties.

I was hoping to get to 25x expenses by age 45, but might settle for 22x expenses instead, just to have more time with my family and for hobbies. At 0.8 FTE we'd still save money, about 20% of our income. This money excludes college savings which will be about $500k by then, barring a market meltdown, and my kids will be 9 and 11 at that time.

What do you think? Would you feel comfortable cutting your hours and (probably semi-permamently) lowering your career trajectory with these numbers? For simplicity make this purely a numbers question, not a life satisfaction question. thanks.



Original Post: This is a serious, actionable post. I hope it will remain unlocked as long as conversations avoid the political and speculative.

I do not see a long term future for me in medicine. The eroding loss of control is staggering and the rewards diminishing rapidly.

Right now I make a comfortable income as most docs do. That may continue for a while, and maybe it will never change. But I want a back up plan.

My back up plan is currently twofold. There is an alternative scenario which currently is less appealing but might be more realistic.

First, in six years I need to be able to walk away from any particular job, work half time or part time - in other words, my work income needs to support only our current expenditures, not savings. My goal is to have 25x our annual spending saved by age 45. Separately we'd have a college fund for the kids. We would still have a mortgage. Question: would you feel comfortable "not saving any more" if you had 25x annual expenses saved by age 45? We wouldn't draw it down; but we wouldn't add to it any more. We are invested 60/40 and anticipate leaving that alone for some time. We would still have the bugaboo of a mortgage, though we might be able to move and downsize without being tied to a particular job. We currently live on about 1/3 of our annual gross income and my wife would continue to work, so if I made even 1/3 of what I make now we could live off it. Not to mention taxes would be lower.

Second, I will spend the next six years attaining a CFP or CFA (probably the former) and somehow gaining the necessary experience to be certified. The goal would then be to work in some combination of personal finance and moonlighting as a physician to make an annual income. I have a CFP friend who after 10+ years is striking out on his own and may be ready for a part-time partner in about 6 years. His philosophy is Boglehead compatible even if it isn't Boglehead strictly.

The 'alternative scenario' is to open a private practice, but the time required to get it up and running, the upfront investment, and the hassle of dealing with insurance companies is a total turnoff, even if I might make more money in the long run. A cash only practice is likely not viable where I live, even 10-20 hours per week. This isn't a rich metro area like LA, SF, or NYC.

What do you think of this outline? What have other docs thought about doing? In my work I see a big difference between older docs whose attitude is, "It's too late for me to change anything," and younger docs whose attitude is, "I can't afford to do anything else, I owe too much $$$." I'm somewhere in the middle. I'm trying to get to "can afford to change" before I'm "too old to change."

I've thought about a job change but the reality is: I don't think a different employer changes the larger dynamic about working in medicine. I actually like my job and the people I work with, but more and more I'm just an automaton, a widget maker, an algorithm adherent. I don't think doing the same job with another employer is the answer.

Also there is no question part of my motivation is to work less. My hobby requires consolidated time off (4-7 days in a row) so it's hard to squeeze that into a full time work schedule.

Appreciate any thoughts, personal experiences or plans.
Last edited by letsgobobby on Fri Feb 28, 2014 3:40 pm, edited 1 time in total.
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Re: medicine a dead end: now what?

Postby Jfet » Wed Apr 24, 2013 5:20 pm

Wow that would be quite the change! I don't suppose you live in a small fishing village and have developed hemophobia?

I think this is an interesting thread, as it would relate to other higher income earners who want a change or backup plan.
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Re: [physician wants to explore career options]

Postby Valuethinker » Wed Apr 24, 2013 5:23 pm

Read Herminia Ibarra's book on career change (working identity or something like that).

Short answer: career change is an adaptive incremental process. Doesn't happen in one big jump. You need information (ie experience) of other careers eg working in a CFP office for 2 weeks during your vacation.

Try to talk to William Bernstein, as a medic who has made that jump. There are doubtless others (dr Michael Bury in The Big Short by Michael Lewis, for one).

The more savings you have when you make the jump, the better off you will be.
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Re: medicine a dead end: now what?

Postby Gauss44 » Wed Apr 24, 2013 5:24 pm

I am a non-traditional pre-med. Would you, or anyone, be willing to warn me about the problems you speak of? You can PM me to keep this thread on topic. After reading your post, I'm wondering if I'm next to encounter the same problem.
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Re: [physician wants to explore career options]

Postby Alex Frakt » Wed Apr 24, 2013 5:24 pm

letsgobobby wrote:This is a serious, actionable post. I hope it will remain unlocked as long as conversations avoid the political and speculative.

I am assuming you are sincere, so I have changed the title of the thread from the (political and speculative) original.
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Re: [physician wants to explore career options]

Postby Bogle101 » Wed Apr 24, 2013 5:30 pm

what is the hobby that you need to take a week off to enjoy?
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Re: [physician wants to explore career options]

Postby Random Poster » Wed Apr 24, 2013 5:36 pm

letsgobobby wrote:Question: would you feel comfortable "not saving any more" if you had 25x annual expenses saved by age 45?


It depends.

Part of me says "no," but that part is driven primarily by my obsessiveness about saving money. I'd be afraid that if I'm not saving anything--even if I don't have to save something--then I'm being wasteful and imprudent.

Part of me says "yes," but that part is driven primarily by the thought that the investments should outgain--however modestly--inflation, so having saved 25x annual expenses now should equal having saved 25x annual expenses later.

Of course, who knows what the future may bring--and so I am inclined to go with my "no" response.

letsgobobby wrote:Second, I will spend the next six years attaining a CFP or CFA (probably the former) and somehow gaining the necessary experience to be certified. The goal would then be to work in some combination of personal finance and moonlighting as a physician to make an annual income. I have a CFP friend who after 10+ years is striking out on his own and may be ready for a part-time partner in about 6 years. His philosophy is Boglehead compatible even if it isn't Boglehead strictly.


I realize that some people make some money doing so, but I do wonder how much money there is in essentially advising people to invest in index funds on their own. I fail to see how one earns a great deal of money by advising people to, essentially, open up an account at Vanguard and invest with them.

letsgobobby wrote:What do you think of this outline?


Sometimes, I wish that I had the guts to actually follow my dreams.
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Re: [physician wants to explore career options]

Postby letsgobobby » Wed Apr 24, 2013 5:46 pm

the hobby is backpacking.
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Re: [physician wants to explore career options]

Postby Jfet » Wed Apr 24, 2013 5:53 pm

letsgobobby wrote:the hobby is backpacking.


awesome hobby! you should hike the West Coast Trail on the rim of Vancouver Island if you ever get the chance. Definately something I was glad I did in my late 30s and not my 60s.

back to your thread topic, sorry.
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Re: [physician wants to explore career options]

Postby dhodson » Wed Apr 24, 2013 6:03 pm

i realize we face many challenges as physicians but i think you are being overly pessimistic.

i also worry that this is a grass is always greener some place else type of view. in this digital age, i wouldnt be surprised if financial advising becomes a tough job. first off they dont typically add much to the equation if you have read even the simple boglish books and margins on what is appropriate to charge are likely going to get squeezed as more people realize costs matter.

Id stick with medicine in short and try to recapture or increase what you enjoy within the field. Id even do a second residency before quitting medicine but thats just me.
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Re: [physician wants to explore career options]

Postby bottomfisher » Wed Apr 24, 2013 6:13 pm

I realize that some people make some money doing so, but I do wonder how much money there is in essentially advising people to invest in index funds on their own. I fail to see how one earns a great deal of money by advising people to, essentially, open up an account at Vanguard and invest with them.


I think its a reasonable option if you actually find yourself arriving at the fork in the road. Most other career changes would require your full-time effort. Financial planning may allow to transition slowly if the right opportunity were to present itself. For example, just visiting with clients a couple afternoons (or mornings) a week. If things work out, you may be able to gradually commit more time to financial planning and less to medicine. While at the same time having medicine as your safety net and maintain your lifestyle (hopefully) while building your financial planning career. The other aspect is that you could have niche practice "specializing" in financial planning for physicians and dentists. You're downplaying the role you could potentially have in a financial planning practice. Everyone here knows that investing can be as simple as low-cost indexing. But many physicians aren't aware of this. Financial education to physicians can be a key component to your offerings. Physicians (like anyone) can learn all they need to know with 3 or 4 basic investing books. But the truth is many will not. And that's where you can fit in. Your experience as a physician may provide physician clientele with immediate trust others in the field would need years to develop. And physicians tend to have more financial planning needs than others. So your services can be so much more than advising on low-cost index funds. Learn everything about malpractice insurance, health insurance, tax planning estate planning, student loan repayment, career changes, retirment planning, etc and you see you have potentially a slew of advice to provide physicians were you to decide to become a financial planner. Truth is physicians could go to whitecoatinvestor and learn it for free. But many will not and thats where you could fit in!
I'm in the young and too many loans camp to consider anything else at his time. I admire you if you have 25x annual spending by 45 yrs old. I will not be anywhere close.
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Re: [physician wants to explore career options]

Postby serbeer » Wed Apr 24, 2013 7:07 pm

I am afraid 25x of expenses saved is just not enough to retire at 45.
4% rule works for more common 30yo retirement horizon that normally corresponds to retirement at 65.
For 50 years horizon you are looking at <3% safer withdrawal rate, and, hence, more like 35x of expenses saved.

Just FYI, perpetual safe withdrawal rate has historically been 2.1% but you don' need to go that low.
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Re: [physician wants to explore career options]

Postby Jfet » Wed Apr 24, 2013 7:13 pm

serbeer wrote:I am afraid 25x of expenses saved is just not enough to retire at 45.
4% rule works for more common 30yo retirement horizon that normally corresponds to retirement at 65.
For 50 years horizon you are looking at <3% safer withdrawal rate, and, hence, more like 35x of expenses saved.

Just FYI, perpetual safe withdrawal rate has historically been 2.1% but you don' need to go that low.


He said he would stop contributing when he reached 25x expenses (estimated at age 45) but he would not touch the money until I guess age 60.

Based on that, the money should grow to at least 35x expenses during those 15 years, even with no additional contributions, assuming he gets a 2% real return (not unrealistic).
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Re: [physician wants to explore career options]

Postby Bmac » Wed Apr 24, 2013 7:15 pm

letsgobobby wrote:This is a serious, actionable post. I hope it will remain unlocked as long as conversations avoid the political and speculative.


Right now I make a comfortable income as most docs do. That may continue for a while, and maybe it will never change. But I want a back up plan.

My back up plan is currently twofold. There is an alternative scenario which currently is less appealing but might be more realistic.

First, in six years I need to be able to walk away from any particular job, work half time or part time - in other words, my work income needs to support only our current expenditures, not savings. My goal is to have 25x our annual spending saved by age 45. Separately we'd have a college fund for the kids. We would still have a mortgage. Question: would you feel comfortable "not saving any more" if you had 25x annual expenses saved by age 45? We wouldn't draw it down; but we wouldn't add to it any more. We are invested 60/40 and anticipate leaving that alone for some time. We would still have the bugaboo of a mortgage, though we might be able to move and downsize without being tied to a particular job. We currently live on about 1/3 of our annual gross income and my wife would continue to work, so if I made even 1/3 of what I make now we could live off it. Not to mention taxes would be lower.

Second, I will spend the next six years attaining a CFP or CFA (probably the former) and somehow gaining the necessary experience to be certified. The goal would then be to work in some combination of personal finance and moonlighting as a physician to make an annual income. I have a CFP friend who after 10+ years is striking out on his own and may be ready for a part-time partner in about 6 years. His philosophy is Boglehead compatible even if it isn't Boglehead strictly.

The 'alternative scenario' is to open a private practice, but the time required to get it up and running, the upfront investment, and the hassle of dealing with insurance companies is a total turnoff, even if I might make more money in the long run. A cash only practice is likely not viable where I live, even 10-20 hours per week. This isn't a rich metro area like LA, SF, or NYC.

1. It seems like this is a less and less viable option with the way health care is changing. I'm sure it makes a difference depending on your specialty, but the capital investment would likely be significant and you would probably end up having to work much harder with less time off in order to develop a successful practice.

What do you think of this outline? What have other docs thought about doing? In my work I see a big difference between older docs whose attitude is, "It's too late for me to change anything," and younger docs whose attitude is, "I can't afford to do anything else, I owe too much $$$." I'm somewhere in the middle. I'm trying to get to "can afford to change" before I'm "too old to change."

2. I guess I'm a bit more like the former group than the latter, being 49. I generally enjoy my work "9-5," but it is all the call and after hours work that gets to be most annoying as I age. These are really the times when I contemplate a career change. However, whenever I have thought about stopping medicine to do something else, it seems like the combination of potential lost income years and not insignificant risk of never being able to achieve an equivalent income level in the new career doesn't make it worthwhile.

I've thought about a job change but the reality is: I don't think a different employer changes the larger dynamic about working in medicine. I actually like my job and the people I work with, but more and more I'm just an automaton, a widget maker, an algorithm adherent. I don't think doing the same job with another employer is the answer.

3. The grass is always greener . . . Would you simply be changing from the "patient" widget maker to the "IPS" widget maker, adhering to a new set of algorithms?

Also there is no question part of my motivation is to work less. My hobby requires consolidated time off (4-7 days in a row) so it's hard to squeeze that into a full time work schedule.

4. See # 1 above.

Appreciate any thoughts, personal experiences or plans.


Much like you, to this point I have been quite diligent saving a significant portion of our income. I don't think I'm too far off from 25X annual expenses, but have younger children with unknown future college expenses as well as uncertainty of health care coverage until Medicare. Thus, I see myself continuing to work into my mid to late 50s. I hope to have a large enough nest egg to be fairly confident it will last through retirement and have college costs well covered. It just seems like the opportunity cost of switching careers at this point does not pencil out. I'd rather keep plugging away and be able to travel, take classes for enjoyment and completely give up the pager instead of possibly having to work well into my 60s in another field. Of course, you are 10 years younger than me, so YMMV :D
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Re: [physician wants to explore career options]

Postby smiley » Wed Apr 24, 2013 7:34 pm

i think others may have misunderstood your first question - if you have 25x expenses at 45, and don't plan on drawing from it but not adding to it while supporting yourself with spouse's income and your own with other venture, i suspect you'd be fine.

at 40, i've had similar thoughts to your own. i've come up with either taking an academic position if private practice becomes impossible (no control, but working with house-staff and students would be cool), or moving overseas (new zealand? ireland?) to practice.

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Re: [physician wants to explore career options]

Postby zzcooper123 » Wed Apr 24, 2013 7:59 pm

What is your specialty?
You seem to have a bias toward a traditional practice model. There are many options out there for physicians willing to try new things and travel.
Seems like to shame to waste all those years of training because the current physician marketplace.
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Re: [physician wants to explore career options]

Postby letsgobobby » Wed Apr 24, 2013 8:07 pm

psychiatrist.

I like seeing patients. It's everything else I hate, the old saw.

Also it gets a little tiring seeing so many people suffering all the time. I like teaching and helping. I thought financial planning would be a way to help people/teach people when they're having good times, not just bad.
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Re: [physician wants to explore career options]

Postby EmergDoc » Wed Apr 24, 2013 8:11 pm

Are you sure you'd enjoy being a financial planner more than a doctor? I see a viable side career doing that (or real estate) but the truth is I like medicine more for now. A lot of the things I don't like about medicine are issues that a financial planner would also deal with (like crazy people.)

You might also start doing some advising on the side and ease into it slowly. Then if it looks like you don't really like it, you've still got medicine to support the family.

It's kind of sad in a way to see someone who spent over a decade learning knowledge and skills that will really benefit society hating his work so much he's willing to basically do anything he can to get out ASAP.
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Re: [physician wants to explore career options]

Postby ram » Wed Apr 24, 2013 8:15 pm

Valuethinker wrote:Short answer: career change is an adaptive incremental process. Doesn't happen in one big jump. .


I agree with this.

I am a physician and have thought about it. I also am not as pessimistic as you seem to be about the medical profession. I will agree that it is going downhill, but we may disagree about the slope of the decline. I am older than you and am not willing to make 'drastic' changes. But I have made some changes. I used to be almost 100% clinician. I have now transitioned to about 60% clinician, 30% clinical researcher and 10% medical teaching. As you can imagine the research and teaching pays less, but I enjoy it more and I believe that it will help me stay in the profession longer. At the present time I need to contribute to savings but once I reach an acceptable level I hope to do only part time teaching and research (and see patients in clinic only and with residents/fellows only. No hospital call.) to support my current income and leave the savings to grow till I am ready to retire completely. It is possible that I will be happy enough in this situation that I will continue in medicine this way till I die or get dementia. My employer supports such transition. There are physicians who are 70+ in my organization. I have also volunteered for administration/ management roles in my medical organization and see that as a possible future option.

I know people who have transitioned to - residency program director, faculty at nursing / pharmacy school teaching anatomy, physiology, clinical medicine etc. Some have become reviewers of medical records at insurance companies making determinations of coverage. This is mostly done by nurses but needs physician oversight. Some younger physicians with good computer skills are working as Information Systems director. Some are developing the CPOE (computerrized physician order entry). A physician colleague was recently hired by a lawyer for a few hours to help his client get social security disability.

Currently I volunteer to teach an occasional class for biology/ anatomy & physiology at the local high school from where my kids graduated and for premed students at the university. I also volunteer to train the H.S. science olympiad team on weekends when they have medical related questions. Wonder if this can become a job for someone who may be interested.( perhaps unlikely)

You will notice that all of these jobs need the person to have been a physician at some point in his life, if not at the current time. Some of these may not need active board certifications and state licences.

Also there are a FEW physician led organizations that still survive to this day. These are usually in the 'non desirable' part of the country. Billings clinic, Scott and White clinic come to mind. There will presumably be more physician autonomy at such sites.

NO . I will not be satisfied with 25X. I hope to target 33.3 X and if it means working longer then so be it. Hope this helps. In fact I will be following this thread for other inputs. Thanks for bringing this up.
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Re: [physician wants to explore career options]

Postby iceman99 » Wed Apr 24, 2013 9:22 pm

I don't think I could leave medicine entirely.

As another poster has mentioned I too am thinking about diversifying my practice by becoming more involved in research and teaching with the residents.

Physician burnout is a reality that people don't fully appreciate given the relatively higher salaries we make.

OP, maybe you should consider taking a sabbatical.
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Re: [physician wants to explore career options]

Postby market timer » Wed Apr 24, 2013 9:27 pm

Financially, I think you will be fine no matter what you do. That realization may be what is prompting this existential crisis. When we have everything we want, we create reasons to be unhappy. Your concerns about the future of medicine are probably exaggerated by this--I have no doubt you will continue to earn a great living regardless of changes in the medical field.

letsgobobby wrote:Also it gets a little tiring seeing so many people suffering all the time. I like teaching and helping. I thought financial planning would be a way to help people/teach people when they're having good times, not just bad.


Valuethinker hit the nail on the head with his recommendation to approach career change as an adaptive incremental process. Based on what you wrote above, I'd suggest a couple paths: (1) try to get a position as an adjunct or clinical psychiatrist at a medical school, (2) combine your interest in finance and background in psychiatry by counseling finance professionals. The latter may require a relocation to a city like Chicago or NYC. I'm not sure there is room for more than one William Bernstein (a physician who writes about asset allocation), but there may be an audience for a psychiatrist to write about how to cope with the stress of trading and/or or do-it-yourself investing. Something I've personally found very interesting is how the perception of risk is so dependent on how decisions are framed.
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Re: [physician wants to explore career options]

Postby am » Wed Apr 24, 2013 9:33 pm

I agree with OP. I am a physician also. There is complete loss of control and destiny since much of what we do is controlled by the government. They cut our reimbursements, impose burdensome regulations, etc. Gov. Cuts are followed by private payers. There is no medical malpractice reforms on the horizon.

Irregular hours beat you down. My pay is lower than when I started 8 years ago out of fellowship in both real and nominal dollars and going down more every year! Constantly carrying high levels of responsibility and risk for many years wears you down. Jealous of some of the techs I work with who make comfortable money but punch in and out with bankers hours on the dot. Would love to do something else but would be hard on my family and my skills are so specialized that it would be hard to apply them somewhere else. Would anyone be interested in starting a hedge fund with me? Sure there are people that would hand over money to MDs with "inside knowledge" :D PM me.
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Re: [physician wants to explore career options]

Postby ieee488 » Wed Apr 24, 2013 9:53 pm

am wrote:I agree with OP. I am a physician also. There is complete loss of control and destiny since much of what we do is controlled by the government. They cut our reimbursements, impose burdensome regulations, etc. Gov. Cuts are followed by private payers. There is no medical malpractice reforms on the horizon.

Irregular hours beat you down. My pay is lower than when I started 8 years ago out of fellowship in both real and nominal dollars and going down more every year! Constantly carrying high levels of responsibility and risk for many years wears you down. Jealous of some of the techs I work with who make comfortable money but punch in and out with bankers hours on the dot. Would love to do something else but would be hard on my family and my skills are so specialized that it would be hard to apply them somewhere else. Would anyone be interested in starting a hedge fund with me? Sure there are people that would hand over money to MDs with "inside knowledge" :D PM me.


Looking on the positive side at least your job is one where there always will be a demand.

I have worked the past 20 years in an area where most of the jobs went overseas because a great majority our manufacturing base went overseas. Fortunately, I can get a security clearance and work for a government contractor.
I am making less now than I did 10 years ago too.
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Re: [physician wants to explore career options]

Postby Gauss44 » Wed Apr 24, 2013 10:06 pm

"I thought financial planning would be a way to help people/teach people when they're having good times, not just bad."

Not an answer to your question, but considering you said the above, have you considered marketing yourself to people who are NOT going through bad times? Maybe there's a way to help people better themselves, self improvement. Help people in fine shape be all they can be, a personal best.
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Re: [physician wants to explore career options]

Postby VictoriaF » Wed Apr 24, 2013 10:08 pm

Index-fund investing is easy, but there is more to financial planning than choosing a 3-fund portfolio. Here are some examples of where a Boglehead-friendly financial planner could help:
01. A prudent way to move from a current high-expense-ratio provider to Vanguard.
02. Decisions about terminating annuities and other disastrous contracts.
03. Handling dollar-cost averaging or value-cost-averaging.
04. Asset allocation among multiple plans including 401(k), 403(b), TSP, IRA, etc.
05. Calculations related to the desirability of Roth accounts.
06. Handling HSA accounts.
07. Handling 529 plans.
08. Fixed income decisions such as timing of I Bonds and EE bonds, buying TIPS at auctions and secondary market, rolling Treasury bills.
09. Watching out re-balancing bands.
10. Helping to design the distribution phase.
11. Helping to resolve financial disputes, e.g., with spouses, parents, siblings, children.
12. Hand holding during downturns.

letsgobobby could offer annual contracts to well-to-do clients, e.g., other physicians, to take care of these or similar financial matters. Instead of collecting based on the AUM he could charge a flat annual fee.

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Re: [physician wants to explore career options]

Postby staythecourse » Wed Apr 24, 2013 10:10 pm

Excellent thread.

Not sure if it belongs on Bogleheads, but is an issue that does not get talked about much. Folks in the field have a "sign of weakness" mentality when discussing such issues and the general public thinks we make money so what are we complaining about. My wife and I are both physicians, both are sisters are physicians, and so are both are dads so it runs in the family so to speak. We talk about this often. I love practicing medicine and helping pt's, but the production pressure and the fact pt's are NEVER fully happy make it draining. I can't think of another field in life where folks think it is normal to call you at any hour of the day and expect you to pick up the phone and give FREE advice. Feel like patients think we are machines and are "on" all the time.

I have thoughts about leaving as well, but figure work negatives/ BS exist in EVERY field in life and in medicine is likely much better then most. The great aspects of medicine, such as: recession proof, high income, etc... really can't be matched.

My personal plan is to make a ton of money so I can leave whenever I want. I figure the BS of any job weighs one down less when you can basically so [(offensive language removed) - admin LadyGeek]. It isn't the getting out of working at that time that matters, but the ABILITY/ CHOICE to if I so wanted. If an administrator or patient got on my nerve I would just tell them to get lost and if the bosses didn't like it I would just retire. That is true power. That is the best part of financial freedom to me. Not taking advantage of it, but having the ability to do it if I wanted.

This is the reason I view risk differently in investing. I don't see short term volatility of markets WORSE then me having to work longer since the probability of lower returns with more conservative allocation is more then a more aggressive approach. I could care less if my portfolio goes up, down, and sideways as long as I have the best chance on the upside when I look at it in 10+ yrs.

Good luck on your choices.
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Re: [physician wants to explore career options]

Postby am » Wed Apr 24, 2013 10:34 pm

staythecourse wrote:Excellent thread.

Not sure if it belongs on Bogleheads, but is an issue that does not get talked about much. Folks in the field have a "sign of weakness" mentality when discussing such issues and the general public thinks we make money so what are we complaining about. My wife and I are both physicians, both are sisters are physicians, and so are both are dads so it runs in the family so to speak. We talk about this often. I love practicing medicine and helping pt's, but the production pressure and the fact pt's are NEVER fully happy make it draining. I can't think of another field in life where folks think it is normal to call you at any hour of the day and expect you to pick up the phone and give FREE advice. Feel like patients think we are machines and are "on" all the time.

I have thoughts about leaving as well, but figure work negatives/ BS exist in EVERY field in life and in medicine is likely much better then most. The great aspects of medicine, such as: recession proof, high income, etc... really can't be matched.

My personal plan is to make a ton of money so I can leave whenever I want. I figure the BS of any job weighs one down less when you can basically so [(offensive language removed) - admin LadyGeek]. It isn't the getting out of working at that time that matters, but the ABILITY/ CHOICE to if I so wanted. If an administrator or patient got on my nerve I would just tell them to get lost and if the bosses didn't like it I would just retire. That is true power. That is the best part of financial freedom to me. Not taking advantage of it, but having the ability to do it if I wanted.

This is the reason I view risk differently in investing. I don't see short term volatility of markets WORSE then me having to work longer since the probability of lower returns with more conservative allocation is more then a more aggressive approach. I could care less if my portfolio goes up, down, and sideways as long as I have the best chance on the upside when I look at it in 10+ yrs.

Good luck on your choices.



Agree with above. We do not often talk about the FU aspect of financial freedom. This is priceless. Going to work with this feeling can make a huge difference.

Production aspects of medicine have become much worse. Great pressure to do more for less. And recession proof does not hold true for all specialties. Look at radiology and pathology recently.
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Re: [physician wants to explore career options]

Postby michaelsieg » Wed Apr 24, 2013 10:50 pm

letsgobobby
I read your post with great interest - I am a physician also and I have to admit that there are moments where I think about doing something different. It is the feeling that a hamster must have running in his wheel and not making any progress - but then again there are these great moments, where I know that I would not want to do anything else. I am a surgeon, but I think your work is emotionally much much harder than mine. For once I have to disagree with Emergdoc, I did not have the impression that you hate your work and you would do anything to leave medicine, but I think you are doing the right thing by taking a step back and checking your options.
I personally would advice against a radical sudden career change and it might be a good idea to observe yourself and see what part of your work that you enjoy most (and maybe you like all of it, but you simply work too much). Since your have good savings, you have the luxury that you could earn less for a while, you could consider teaching, which in our field in my opinion is the best medicine against any kind of burnout, or you could simply consider working less hours, and then do something you always wanted to do, but didn't have the time to do, maybe writing a book, or start playing an instrument again or get the financial degree you mentioned -take time for yourself and see where life takes you.
Good luck!
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Re: [physician wants to explore career options]

Postby SGM » Wed Apr 24, 2013 11:03 pm

You might want to read "First Do No Harm," (Being a resilient doctor in the 21st century), by Leanne Rowe and Michael Kidd. We must expand the Hippocratic Oath to include doing no harm to ourselves. Job number 1 for me is to make home a sanctuary,to value strong relationships and to treat conflicts as opportunities. Check it out.

Personally, I love the patients and ignore the noise.
"Let us endeavor, so to live, that when we die, even the undertaker will be sorry." Mark Twain
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Re: [physician wants to explore career options]

Postby letsgobobby » Thu Apr 25, 2013 1:04 am

Durn! I just found out there is *already* a "financial psychiatrist" out there! The good news is she lives halfway around the world and her website is down. :D

http://www.cnbc.com/id/26954107
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Re: [physician wants to explore career options]

Postby DualIncomeNoDebt » Thu Apr 25, 2013 1:59 am

Examine the "grass is greener" phenomenon. As someone who works regularly in finance, I've known a lot of accountants, CFAs, CFPs, etc. There is a lot to dislike about accountant-related jobs. The details can be mind-numbing. How do you feel about staring at Excel spreadsheets all day? If you have clients, how about responding to emails, messages and phone calls nonstop when markets or tanking?

Malpractice liability is a risk in all professions. Recommended a batch of investments that went south due to accounting fraud or some other misrepresentation by a financial institution (and you had nothing to do with it)? You'll be named in the arbitration action or state/federal lawsuit, guaranteed. These are the type of clients that will have the means and ability to pursue you for years -- and this time, you may not have hospital + med. mal. insurance defense to back you up.

OP, have you thought about going part-time? Is it even possible? Sounds to me going part time in such an in-demand profession like medicine -- with all your skill and training -- is vastly superior to being another numbers monkey.

Much of what you write is prevalent in every profession today. The world is so damn complex today, and much blame goes to middlemen, management, and the paperpusher infrastructure surrounding white collar professions. No matter what you are doing, the work sucks, and oftentimes, dealing with people sucks too. This is why I say finding a real niche gig, something part-time with hours you control, could be just the ticket for you.
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Re: [physician wants to explore career options]

Postby awval999 » Thu Apr 25, 2013 4:37 am

Here's an idea---

I work at the Cleveland Clinic (pharmacist, not physician).

The physicians at the Clinic are all salaried. They practice medicine. The hospital employers the billers, insurance agents, pays for the malpractice insurance, etc. You obviously are limited financially because you won't be able to financially "grow" your practice but you can practice medicine and get paid every two weeks.

Is there any opportunity to be a salaried physician where you live?
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Re: [physician wants to explore career options]

Postby LH » Thu Apr 25, 2013 4:58 am

I am right with you.

Early 40s.

I think I will drop to half time and/or change jobs.

Will try to gut it out a few more years.

Amazing the degradation in medicine is it not? Me and my colleague were just discussing how nonsensical it has become tonight.

Same thought, just earn expenses, save little to nothing here on out in a few years or so, I actually did an outline of it just last week.

Gotta think hard though, the money is good, but then again the money isn't everything.

A friend was saying one could work for EPA, CDC etc. that after three years, you are vested, and would get at least some pension starting age 62.
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Re: [physician wants to explore career options]

Postby Gleevec » Thu Apr 25, 2013 6:48 am

I sympathize with your feelings about medicine completely, but where else would you go?

Law is notoriously going down the tubes in flaming fashion (can you imagine if Mayo Clinic just crumbled? Because equivalent stature firms have failed in the past few years)
Finance is being downsized greatly. More importantly you tend to have live in NYC which makes everyone feel (and be) poor
Engineering is being outsourced
Science is underfunded with serial low-paying post-doc positions and few university positions
A bunch of the "hot" fields: PA/NP, PT, etc are being oversaturated (plus you would probably not like having even less autonomy than you do now)
Union manufacturing jobs are getting outsourced or insourced to right to work states

Medicine is definitely not what it used to be, but I dont see a field out there where the short or long-term prospects are better.
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Re: [physician wants to explore career options]

Postby RooseveltG » Thu Apr 25, 2013 7:13 am

You may want to consider working with a career coach advising physicians. I was ready to leave medicine 12 years ago. Coaching helped me to identify what I liked about practicing and the alternatives. It also made me realize I had a choice and the grass was not greener elsewhere.

You may also be burned out and a coach can help with that as well. Most physicians are reluctant to spend the money to obtain good coaching. The small cost helped me through another decade of practice. It may have been the best "investment" I ever made.

Please PM me if you want a recommendation. (I receive no financial compensation from any coach nor do I do it myself).

Roosevelt.
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Re: [physician wants to explore career options]

Postby SnapShots » Thu Apr 25, 2013 8:42 am

am wrote:. Would anyone be interested in starting a hedge fund with me? Sure there are people that would hand over money to MDs with "inside knowledge" :D PM me.


This made me LOL!! After being involved in medicine and doctors for well over 45 years, it is the rare doc that has much business acumen. :wink:

Patients love their doctors. I doubt investors will feel the same.
the best decision many times is the hardest to do
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Re: [physician wants to explore career options]

Postby johnubc » Thu Apr 25, 2013 9:12 am

You have had a good and successful first career - I know many people retiring at 65 that would like to have 25 years of expenses saved.

Are you sure you are tired of the medical field - you could be just be getting a mid life itch to change careers - the gloom you expect may not happen - your employment can change for the better. There could be future regulation in the financial industry that you will not like. I would look towards employment where you do not have to deal with the parts that you do not like - ie, become part of a practice where you are an employee who does not have to worry about the billing and regulatory end of the business. Rx sales? MD Advisor to medical companies?
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Re: [physician wants to explore career options]

Postby letsgobobby » Thu Apr 25, 2013 5:06 pm

There have been many thought-provoking responses to my OP, and I am digesting them all. Thanks as well for several PMs.

I am intrigued by the coaching idea. I'll look into that.

I have to say that finding a way to combine psychiatry, psychology, and finance would really be ideal. I don't think I have it in me to pursue an academic degree (ie PhD in econ or finance with behavioral finance as my specialty, brain imaging, biometric markers of risk tolerance etc) - while I think there is an enormous future there, I don't believe I have the disposition for such long term goals. I might explore an academic position (even volunteer) at our local research medical school; maybe there's a way I can grow an interest into a specialty that then creates career opportunities, whether in or out of medicine.

To be clear, I am not *today* at 25x spending. If we stay focused and markets don't tank that is achievable in 6 years. Psychology has shown that having thought about and clearly visualized future goals makes them more tangible and makes people more able/willing to strive toward them. If I also know that 25x spending gives me the freedom to step off the treadmill, I think I can stay on the ball the next six years - ie, I can delay any burnout at least until then.

thank you all,
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Re: [physician wants to explore career options]

Postby msj16 » Fri Apr 26, 2013 6:18 pm

Just wanted to add:

I recently have been in touch with someone who is in the know regarding issues pertaining to Obamacare. (this is not a political post). My understanding is that with states required to form affordable care organizations-that private practise will no longer be viable in certain states in about four to five years. Physicians will need to band together into larger care organizations. I would wait a few years to see how all of this plays out. Also, I think burn-out is likely a huge factor in this - consider perhaps even working with a specialty patient population if possible. Lastly, you have to consider how comfortable you are with marketing and sales, otherwise those non-steady income jobs can be stressful. I would try on your "marketing hat" now to see how comfortable you are with it.
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Re: [physician wants to explore career options]

Postby SGM » Fri Apr 26, 2013 7:43 pm

Valuethinker wrote:Read Herminia Ibarra's book on career change (working identity or something like that).

Short answer: career change is an adaptive incremental process. Doesn't happen in one big jump. You need information (ie experience) of other careers eg working in a CFP office for 2 weeks during your vacation.

Try to talk to William Bernstein, as a medic who has made that jump. There are doubtless others (dr Michael Bury in The Big Short by Michael Lewis, for one).

The more savings you have when you make the jump, the better off you will be.


I talked to Bill Bernstein last year and asked him about his career change. He stated that he never was meant to be a doctor. The impression I had was that he had never practiced or practiced for a very short period of time. Anyway, in my opinion, an M.D. degree is a door opener, not a door closer.
"Let us endeavor, so to live, that when we die, even the undertaker will be sorry." Mark Twain
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Re: [physician wants to explore career options]

Postby Big Worm » Sat Apr 27, 2013 1:31 am

Another physician, just recently joined.

I was talking to the guy who does our billing today. His company also handles the billing for a hospital about 30 minutes away. The other hospital will be the first in the state to use an ACO model with supposedly a single payment to be split up. This could potentially be disastrous for many of us.

I am as pissed off and burned out as anyone but I keep humping it. Nothing else I have any interest in could possibly make me as much money as I do now. I am going to keep going while the going is still (relatively) good.
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Re: [physician wants to explore career options]

Postby bayview » Sat Apr 27, 2013 8:20 am

You're a psychiatrist? The VA is hiring. Boy, are we hiring.

I don't know (pretty much doubt) that you'd be able to work your schedule the way you'd like it, but it's salaried, it has set hours, and people like me do your coding and billing. (Just complete your encounters and sign your notes, please. Thank you.) Oh, and you get TSP. :happy

Before you mentioned that you were in psychiatry, I was going to suggest something along the lines of emergency medicine/ urgent care/ hospitalist, where you could get with a group that schedules one week on, one week off. That would still have the billing hassles, etc., although presumably your group would take care of a lot of this. But in my pre-VA days, I worked with quite a few hospitalists, and they were happy with that type of schedule.
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Re: [physician wants to explore career options]

Postby ks289 » Sat Apr 27, 2013 8:39 am

I am sure most docs have shared your frustrations and concerns about practicing medicine.
I admire your ability to think big about making a change to your career and pursuing your interests and yet take such meticulous care with your planning.

2 cents about your well thought out plan.
I would hesitate to not save additional funds for retirement even after saving 25x expenses at that young age. I would be nervous about unforeseen circumstances forcing me to run negative and dip into savings early.

Your alternative plan (private practice) sounds certainly reasonable, but those in private practice currently lament the loss of autonomy, rising costs (emr), and declining reimbursements as the new normal which is already pushing docs into employed positions. Going against the tide here seems to be getting more and more difficult. Certainly I would fear much less time for hobbies.

I love the thoughts from the other posters about transitioning/diversifying into teaching/administration. Burnout and ageism exist in medicine (possibly more so in procedural specialties) so it is great foresight to be planning ahead carefully like this.

Good luck.
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Re: [physician wants to explore career options]

Postby Bmac » Sat Apr 27, 2013 9:27 am

Big Worm said,

Nothing else I have any interest in could possibly make me as much money as I do now. I am going to keep going while the going is still (relatively) good.


Ditto. Between the potential loss in earnings while learning a new career and lack of guarantee of ever getting back to the same income level once the change is made, I'll stick with medicine.
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Re: [physician wants to explore career options]

Postby letsgobobby » Sat Apr 27, 2013 10:12 am

this morning I learned three and possibly four of our ED docs have quit. Two want out of medicine entirely. The other two are disillusioned with our patient population (heavy Medicaid, lots of substance abuse, etc). It's going to take a huge toll on our hospital while they find locums and recruit, again. What shocks me is all four of these docs are in their thirties and early forties. None of them is old.
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Re: [physician wants to explore career options]

Postby hicabob » Sat Apr 27, 2013 10:42 am

My ex works at Kaiser Permanente - salary is lower than most docs expect (200k perhaps??) but benefits are great and the docs actually have a life.
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Re: [physician wants to explore career options]

Postby Bracket » Sun Apr 28, 2013 10:53 pm

This is funny. First time I ever checked out the "non-investment" bogleheads forum and I find this thread. Also a physician, anesthesiologist, been in practice for ~7 years. First four in the Navy, now working as a salaried employee for a big soul-less company. About 3 years ago I got really into cooking, so much so that I was trying to figure out a way to keep practicing and go to culinary school at the same time. Couldn't crunch the numbers (oh, and my wife thought I was out of my mind). Lately I've been spending time learning the Boglehead way, writing an IPS, etc and also looking into how one becomes a CFA, again thinking I'd rather do something else besides medicine. So is this simply a "the grass is always greener" situation? Has medicine changed? Or have I changed? I don't know, but it's interesting to see others wrestling with similar feelings.

Military medicine was often very fulfilling, but there was always the whole not getting paid very much problem, the having to move and travel all over the world problem, etc. On the other hand I never had to worry about anything but the medicine, and could always do what I thought was safest and best for the patient. As an employee in private practice it's similar in that i don't worry about billing or those sorts of things, but I spend a lot more time doing "non-physician" tasks. The other downside is that it's now all about production pressure and making money for the hospital and the company. Patient safety? Everyone loves talking about it as long as it doesn't interfere with getting all the cases done. Surgeon threw an instrument across the room? Well yes that is unprofessional, but he does bring a LOT of cases here so maybe we'll just ignore that. Also unlike the Navy I now worry about being sued pretty much every day. Do I really think I need this test? Probably not, but what if...yeah just get the test. I can think of three friends who have been sued, and in each case the suit was, in my opinion, utterly ridiculous. Meanwhile they're spending years dealing with it all.

Anyway, luckily for me I have a very manageable student loan debt and I'm getting paid what I think is a very competetive salary. Then again I am on in-house call all the time, like right now, for example, but that's the deal I signed up for. So for now I think I'm going to have to stick it out, keep dreaming about going back to school in a different field, and hope that I can save enough over the next decade or two to move to a part-time or slower paced practice. I also miss the resident and medical student teaching I did in the military more than I thought I would (I gave it up to go after that money) and maybe academic practice is something I could return to in the future.
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Re: [physician wants to explore career options]

Postby deanbrew » Mon Apr 29, 2013 8:44 am

DualIncomeNoDebt wrote:Examine the "grass is greener" phenomenon. As someone who works regularly in finance, I've known a lot of accountants, CFAs, CFPs, etc. There is a lot to dislike about accountant-related jobs. The details can be mind-numbing. How do you feel about staring at Excel spreadsheets all day? If you have clients, how about responding to emails, messages and phone calls nonstop when markets or tanking?

Malpractice liability is a risk in all professions. Recommended a batch of investments that went south due to accounting fraud or some other misrepresentation by a financial institution (and you had nothing to do with it)? You'll be named in the arbitration action or state/federal lawsuit, guaranteed. These are the type of clients that will have the means and ability to pursue you for years -- and this time, you may not have hospital + med. mal. insurance defense to back you up.

OP, have you thought about going part-time? Is it even possible? Sounds to me going part time in such an in-demand profession like medicine -- with all your skill and training -- is vastly superior to being another numbers monkey.

Much of what you write is prevalent in every profession today. The world is so damn complex today, and much blame goes to middlemen, management, and the paperpusher infrastructure surrounding white collar professions. No matter what you are doing, the work sucks, and oftentimes, dealing with people sucks too. This is why I say finding a real niche gig, something part-time with hours you control, could be just the ticket for you.


This is almost exactly what I was going to write - green grass on the other side of the fence and all of that. Yes, I understand how both the actual work and compensation have changed for doctors. The intrusion of government and insurance rules, regulations and oversight. The thinning profit margins. The feeling of being a cog in a great big machine instead of autonomous Super Doc. Well, guess what? Almost everybody I know in every job and profession feels the same way, including financial planning. Most everyone is working harder and dealing with more red tape, all for either lower income or lower profit margins.

I'm not a physician, so I certainly have no insider knowledge or advise. But it seems to me that there would be medical-related job possibilities that burnt-out doctors could pursue that would be more appropriate and rewarding, yet reduce the particular annoyances like after-hours calls or dealing with insurance companies. Others have mentioned teaching, research and private-pay practice. What about a simple change in environment? Others mentioned working for the government (military or VA).

In my field, I know people who switched from the private sector to government employment. Talk about grass being greener (from my perspective). They no longer have to worry about generating income, dealing with customers or even working very much. They get every holiday under the sun, work short hours and get great benefits. Still, I realize they are dealing with dreadful internal regulations and red tape, a mind-numbing work environment, and lazy coworkers who can't be fired and get paid the same no matter how little work they do.

I'm not saying people should never change careers. It's great to have a career that is rewarding in many aspects, not just one. But it's also important to realize that there are always headaches and problems.
"The course of history shows that as the government grows, liberty decreases." Thomas Jefferson
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Re: [physician wants to explore career options]

Postby zzcooper123 » Tue Apr 30, 2013 10:49 am

I had the exact same thoughts 5-7 years ago. I decided I was very interested in MY OWN finances, but maybe not for others. I realized I was at at the peak of my Medical skills and did not want to throw it all away because of Government and insurance hassles.
Medicine is no longer a profession where you stay in one place for 40 years and "die at your desk". Physicians must be able to find a niche (or several niches) where they can be happy and make a living. Abilities to work with others and get along are valued traits in a physician. They can no longer be the " lone wolf" and practice the way they want to.
Look for multiple streams of income, work several different jobs, learn new skills, be an independent businessman. :sharebeer
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Re: [physician wants to explore career options]

Postby staythecourse » Tue Apr 30, 2013 12:24 pm

letsgobobby wrote:this morning I learned three and possibly four of our ED docs have quit. Two want out of medicine entirely. The other two are disillusioned with our patient population (heavy Medicaid, lots of substance abuse, etc). It's going to take a huge toll on our hospital while they find locums and recruit, again. What shocks me is all four of these docs are in their thirties and early forties. None of them is old.


Hate to say this, but maybe the problem is you work with a lot of medicaid?? My experience is the WORST populations to take care of are the two extremes (medicaid and the rich). The best are blue collar folks and medicare. For me I have noticed completely different levels "strain" depending on which type of patients that walk into my office.

Now that is NOT to say all folks fit that stereotype, but many do.

Good luck.
...we all think we're above average investors just like we all think we're above average dressers... -Jack Bogle
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